Fields marked with an asterisk (
) are required.
To receive your Assisted Living Administrator renewal license, The below items MUST be faxed (334) 271-2420 or emailed email@example.com by the expiration date of your license.
A Copy of NHA license renewal card
A Copy of State license of the assisted living facility for which you have administrative responsibility
Last 4 of SSN:
Policy Related Questions: 334-271-2418Technical Support: 866-353-3468 or